Smoking as a risk factor for dyslipidemia: study among type 2 diabetes mellitus patients on private hospital in Yogyakarta

  • Christine Patramurti Department of Pharmaceutical Chemistry, Universitas Sanata Dharma, Sleman, 55282, Indonesia
  • Dita Maria Virginia Department of Pharmacology and Clinical Pharmacy, Universitas Sanata, Sleman, 55282, Indonesia

Abstract

Smoking behavior is known to be a significant factor that has adverse effects on people with type 2 diabetes (T2DM). Nicotine in cigarettes stimulate adrenoreceptors and promotes lipolysis, leading to the synthesis of free fatty acids, which in turn increase the susceptibility to dyslipidemia and the development of cardiovascular disorders. This study aimed to examine the relationship between smoking status and the occurrence of dyslipidemia in patients with T2DM in a private hospital in Yogyakarta.  A total of 107 T2DM patients participated in this cross-sectional observational study. Through live interviews, we collected smoking status conducted using the Fagerström Test for Nicotine Dependence (FTND) questionnaire.  The fasting blood samples taken from participants were used to analyze the lipid profiles, including triglycerides (TG), total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). The chi-square test revealed a significant association between smoking status and the risk of dyslipidemia among the participants, with χ²(2) = 13.463, p = 0.001. The findings suggest that smoking increases the risk of dyslipidemia among T2DM patients. These results highlight the importance of smoking cessation as a preventive measure to reduce metabolic complications in individuals with T2DM. 

References

[1] IDF, “Asian Association for the Study of Diabetes (AASD),” Tokyo, 2024. [Online]. Available: https://idf.org/our-network/regions-and-members/western-pacific/members/indonesia/

[2] B. Kemenkes, “Survei Kesehatan Indonesia (SKI) Dalam Angka,” Jakarta, 2023. Accessed: Oct. 20, 2025. [Online]. Available: https://www.badankebijakan.kemkes.go.id/ski-2023-dalam-angka/

[3] M. Wahidin, R. I. Agustiya, and G. Putro, “Beban penyakit dan program pencegahan dan pengendalian penyakit tidak menular di Indonesia,” Jurnal Epidemiologi Kesehatan Indonesia, vol. 6, no. 2, Jan. 2023, doi: 10.7454/epidkes.v6i2.6253.

[4] M. E. Pavkov and Y. Miyamoto, Diabetes and kidney disease: IDF Atlas Report 2023, D. J. Magliano, E. J. Boyko, I. Genitsaridi, L. Piemonte, P. Riley, and P. Salpea, Eds., International Diabetes Federation, Brussels, Belgium, 2023. Available: https://www.diabetesatlas.org

[5] C. E. Kosmas, M. D. Bousvarou, C. E. Kostara, E. J. Papakonstantinou, E. Salamou, and E. Guzman, “Insulin resistance and cardiovascular disease,” Mar. 01, 2023, SAGE Publications Ltd. doi: 10.1177/03000605231164548.

[6] S. Kalra and N. Raizada, “Dyslipidemia in diabetes,” Indian Heart J, vol. 76, pp. S80–S82, Mar. 2024, doi: 10.1016/j.ihj.2023.11.002.

[7] Y. Lu, W. Wang, J. Liu, M. Xie, Q. Liu, and S. Li, “Vascular complications of diabetes: a narrative review,” Medicine, vol. 102, no. 40, p. E35285, Oct. 2023, doi: 10.1097/MD.0000000000035285.

[8] X. Zhang et al., “Diabetes-related macrovascular complications are associated with an ıncreased risk of diabetic microvascular complications: a prospective study of 1518 patients with type 1 diabetes and 20 802 patients with type 2 diabetes in the UK Biobank,” J Am Heart Assoc, vol. 13, no. 11, Jun. 2024, doi:
10.1161/JAHA.123.032626.

[9] E. Bahiru, R. Hsiao, D. Phillipson, and K. E. Watson, “Mechanisms and treatment of dyslipidemia in diabetes,” Current Cardiology Report, vol. 23, no. 26, 2022, doi: 10.1007/s11886-021-01455-w/Published.

[10] P. Lim and D. Bleich, “Revisiting cardiovascular risk reduction in type 2 diabetes and dyslipidemia,” Sep. 01, 2022, Elsevier B.V. doi: 10.1016/j.ijcrp.2022.200141.

[11] J. Goldney et al., “Burden of vascular risk factors by age, sex, ethnicity and deprivation in young adults with and without newly diagnosed type 2 diabetes,” Diabetes Res Clin Pract, vol. 220, Feb. 2025, doi: 10.1016/j.diabres.2025.112002.

[12] T. B. Vuong, T. M. Tran, and N. Q. Tran, “High prevalence of prediabetes and type 2 diabetes, and identification of associated factors, in high-risk adults in Vietnam: A cross-sectional study,” Diabetes Epidemiology and Management, vol. 17, Jan. 2025, doi: 10.1016/j.deman.2024.100239.

[13] G. R. Vance, K. Benedict, C. B. Thames, B. F. Hathaway, E. C. Bowen, and M. E. Walker, “Obesity as a risk factor for carpal tunnel syndrome ındependent of diabetes mellitus: a nationwide study,” J Hand Surg Glob Online, pp. 1–6, 2025, doi: 10.1016/j.jhsg.2025.01.016.

[14] C. Patramurti and F. Fenty, “Association of smoking behaviour and glycohemoglobine levels among adults javanese Indonesian Smokers,” JPSC, vol. 17, no. 2, pp. 76–85, 2020.

[15] M. Hanun Siregar et al., “Association of central obesity and smoking with HDL level among Indonesian peoples (18-59 years),” Jurnal Gizi dan Diatetik Indonesia, vol. 8, no. 3, 2020, doi: 10.21927/ijnd.2020.8(3).101-108.

[16] S. Sudikno, J. Pradono, and S. Tuminah, “The Effect of central obesity, smoking, and fried food consumption on dyslipidemia in adults: a prospective cohort study,” in Proceedings of the 1st International Conference for Health Research – BRIN (ICHR 2022), Atlantis Press International BV, 2023, pp. 655–667. doi: 10.2991/978-94-
6463-112-8_60.

[17] F. Fihiruddin, A. Putri, S. Zaetun, and M. W. Diarti, “Differences ın lipid profiles ın diabetes mellitus patients
based on cigarette consumption,” Jurnal Analis Medika Biosains (JAMBS), vol. 12, no. 01, p. 12, 2025, doi: 10.32807/jambs.v12i1.369.

[18] B. Bhowmik et al., “Serum lipid profile and its association with diabetes and prediabetes in a rural Bangladeshi population,” Int J Environ Res Public Health, vol. 15, no. 9, pp. 1–12, 2018, doi: 10.3390/ijerph15091944.

[19] R. J. Keith et al., “Nicotine metabolism in adults with type 2 diabetes,” Nicotine and Tobacco Research, vol. 21, no. 6, pp. 846–849, 2018, doi: 10.1093/ntr/ntx214.

[20] M. C. Nath et al., “The effect of cigarette smoking on fasting lipid profile: a single center study,” Fortune Journal of Health Sciences, vol. 05, no. 02, pp. 363–373, 2022, doi: 10.26502/fjhs.067.

[21] W. Jeong, “Association between dual smoking and dyslipidemia in South Korean adults,” PLoS One, vol. 17, no. 7 July, Jul. 2022, doi: 10.1371/journal.pone.0270577.

[22] M. J. Qasim, I. Q. Falih, and F. K. Al_Husaini, “The correlation between lipid profile and smoking,” Indian Journal of Forensic Medicine and Toxicology, vol. 14, no. 3, pp. 2351–2356, 2020, doi: 10.37506/ijfmt.v14i3.10786.

[23] Sakila and Valamarthi, “A Comparative Study of Lipid Profile among Smokers and Non Smokers,” Journal of Karnali Academy of Health Sciences, vol. 2, no. 1, pp. 4–9, 2019, doi: 10.3126/jkahs.v2i1.24389.

[24] M. Momayyezi, S. Jambarsang, H. Fallahzadeh, and R. Sefidkar, “Association between lipid profiles and cigarette smoke among adults in the Persian cohort (Shahedieh) study,” BMC Public Health, vol. 24, no. 1, Dec. 2024, doi: 10.1186/s12889-024-18734-0.

[25] A. van der Plas, M. Antunes, S. Pouly, G. de La Bourdonnaye, M. Hankins, and A. Heremans, “Meta-analysis of the effects of smoking and smoking cessation on triglyceride levels,” Toxicol Rep, vol. 10, pp. 367–375, Jan. 2023, doi: 10.1016/j.toxrep.2023.03.001.

[26] Z. Chen, X. an Liu, and P. J. Kenny, “Central and peripheral actions of nicotine that influence blood glucose homeostasis and the development of diabetes,” Pharmacol Res, vol. 194, Aug. 2023, doi: 10.1016/j.phrs.2023.106860.

[27] W. Van Zwol, B. Van De Sluis, H. N. Ginsberg, and J. A. Kuivenhoven, “VLDL biogenesis and secretion: ıt takes a village,” Jan. 19, 2024, Lippincott Williams and Wilkins. doi: 10.1161/CIRCRESAHA.123.323284.

[28] BPS DIY, “Persentase Merokok Pada Penduduk Umur ≥ 15 Tahun di Provinsi DI Yogyakarta - Tabel Statistik - Badan Pusat Statistik Provinsi Di Yogyakarta.” Accessed: Jan. 15, 2025. [Online]. Available: https://yogyakarta.bps.go.id/id/statistics-table/2/NDQ2IzI=/persentase-merokok-pada-penduduk-umur-15-
tahun-di-provinsi-di-yogyakarta.html

[29] Soewarso K, Siregar H, Kusuma MAPN, Hikmah L, Fauzi R, Antojo A, editors. Atlas Tembakau Indonesia 2020. Jakarta: Tobacco Control Support Center–Ikatan Ahli Kesehatan Masyarakat Indonesia (TCSC-IAKMI); 2020.

[30] J. Wu et al., “Effects of passive smoking and its duration on the prevalence of prediabetes and type 2 diabetes mellitus in Chinese women,” Aging, vol. 12, no. 10, pp. 9440–9446, 2020.

[31] J. Na et al., “Passive smoking and risk of gestational diabetes mellitus among nonsmoking women: a prospective cohort study in China,” Int J Environ Res Public Health, vol. 19, no. 8, Apr. 2022, doi: 10.3390/ijerph19084712.

[32] A. R. Triyaniarta, S. Martini, K. D. Artanti, S. Widati, and R. D. Nastiti, “Determinants of Type 2 diabetes mellitus among passive smokers,” Kesmas, vol. 17, no. 3, pp. 191–197, Aug. 2022, doi: 10.21109/kesmas.v17i3.5723.

[33] G. Q. Qin et al., “Effect of passive smoking exposure on risk of type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies,” Front. Endocrinol., vol. 14, July 2023, doi: 10.3389/fendo.2023.1195354.

[34] R. Attard, P. Dingli, C. J. M. Doggen, K. Cassar, R. Farrugia, and S. B. Wettinger, “The impact of passive and active smoking on inflammation, lipid profile and the risk of myocardial infarction,” Open Heart, vol. 4, no. 2, pp. 1–8, 2017, doi: 10.1136/openhrt-2017-000620.

[35] K. Miyamura, N. Nawa, A. Isumi, S. Doi, M. Ochi, and T. Fujiwara, “The Association of Passive Smoking and Dyslipidemia among Adolescence in Japan: Results from A-CHILD Study,” Journal of Clinical Endocrinology and Metabolism, vol. 106, no. 7, pp. E2738–E2748, Jul. 2021, doi: 10.1210/clinem/dgab094.

[36] A. P. Okekunle, J. O. Asowata, B. Adedokun, and O. M. Akpa, “Secondhand smoke exposure and dyslipidemia among non-smoking adults in the United States,” Indoor Air, vol. 32, no. 1, Jan. 2022, doi: 10.1111/ina.12914.

[37] K. Fargerstrom, “Determinants of tobacco use and renaming the FTND pharmacological determinants for smoking other than nicotine,” Nicotine & Tobacco Research, vol. 14, no. 1, 2011, doi: 10.1097/FBP.0b013.

[38] R. Goyal, M. Singhal, and I. Jialal, “Type 2 diabetes,” in StatPearls [Internet], Treasure Island (FL): StatPearls Publishing, 2023. doi: 10.1016/S0140-6736(22)01655-5.

[39] Badan Penelitian dan Pengembangan Kesehatan. Laporan Nasional Riskesdas 2018. Jakarta: Kementerian Kesehatan Republik Indonesia; 2019.

[40] Perkumpulan Endokrinologi Indonesia (PERKENI), pedoman pengelolaan dan pencegahan diabetes melitus tipe 2 dewasa di Indonesia, ed. revisi 2021. Jakarta: PB PERKENI, 2021.

[41] A. Kautzky-Willer, J. Harreiter, and G. Pacini, “Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus,” Endocr Rev, vol. 37, no. 3, pp. 278–316, 2016, doi: 10.1210/er.2015-
1137.

[42] M. W. Pataky, W. F. Young, and K. S. Nair, “Hormonal and metabolic changes of aging and the ınfluence of lifestyle modifications,” Mayo Clinic Proc., vol. 96, no. 3, pp. 788–814, Mar. 2021, doi: 10.1016/j.mayocp.2020.07.033.

[43] M. Schorr et al., “Sex differences in body composition and association with cardiometabolic risk,” Biol Sex Differ, vol. 9, no. 1, pp. 1–10, Jun. 2018, doi: 10.1186/s13293-018-0189-3.

[44] P. Srikanthan, T. B. Horwich, M. C. Press, J. Gornbein, and K. E. Watson, “Sex differences in the association of body composition and cardiovascular mortality,” J Am Heart Assoc, vol. 10, no. 5, pp. 1–14, 2021, doi: 10.1161/JAHA.120.017511.

[45] H. G. Jeong and H. Park, “Metabolic disorders in menopause,” Metabolites, vol. 12, no. 10, Oct. 2022, doi: 10.3390/metabo12100954.

[46] K. Erdoğan and N. Sanlier, “Metabolic syndrome and menopause: the ımpact of menopause duration on risk factors and components,” Int J Womens Health, vol. 16, pp. 1249–1256, 2024, doi: 10.2147/IJWH.S460645.

[47] Neuenschwander et al., “Role of diet in type 2 diabetes incidence: Umbrella review of meta-analyses of prospective observational studies,” BMJ, 366, May 2019, doi: 10.1136/bmj.l2368.

[48] F. R. Cavallo, C. Golden, J. Pearson-Stuttard, C. Falconer, and C. Toumazou, “The association between sedentary behaviour, physical activity and type 2 diabetes markers: a systematic review of mixed analytic approaches,” PLoS One, vol. 17, no. 5 May, May 2022, doi: 10.1371/journal.pone.0268289.

[49] S. Smith, B. Salmani, J. LeSarge, K. Dillon-Rossiter, A. Morava, and H. Prapavessis, “Interventions to reduce sedentary behaviour in adults with type 2 diabetes: a systematic review and meta-analysis,” PLoS One, vol. 19, no. 7, pp. 1–20, Jul. 2024, doi: 10.1371/journal.pone.0306439.

[50] Kementerian Kesehatan RI, “Infodatin: Perilaku merokok masyarakat Indonesia berdasarkan riskesdas 2007 dan 2013,” 2015.

[51] D. Campagna et al., “Smoking and diabetes : dangerous liaisons and confusing relationships,” Diabetol Metab Syndr, pp. 1–12, 2019, doi: 10.1186/s13098-019-0482-2.

[52] J. W. Hong, C. R. Ku, J. H. Noh, K. S. Ko, B. D. Rhee, and D. J. Kim, “association between self-reported smoking and hemoglobin A1c in a Korean population without diabetes : The 2011 – 2012 Korean National Health and Nutrition Examination Survey,” PLoS One, vol. 10, no. 5, pp. 1–8, 2018.

[53] H. Akkuzulu, C. Aypak, A. Özdemir, and S. Görpelioǧlu, “Impact of smoking and nicotine addiction on HbA1clevels and diabetic microvascular complications,” Clinical Diabetology, vol. 9, no. 2, pp. 112–117, 2020, doi: 10.5603/DK.2020.0004.

[54] D. Gu, D. Wang, Q. Zhu, L. Luo, and T. Zhang, “Prevalence of dyslipidemia and associated factors in sedentary occupational population from Shanghai: a cross-sectional study,” Archives of Public Health, vol. 82, no. 1, Dec. 2024, doi: 10.1186/s13690-024-01245-0.

[55] R. V. Levy, K. E. Brathwaite, H. Sarathy, K. Reidy, F. J. Kaskel, and M. L. Melamed, “Analysis of active and passive tobacco exposures and blood pressure in us children and adolescents,” JAMA Netw Open, vol. 4, no. 2, Feb. 2021, doi: 10.1001/jamanetworkopen.2020.37936.

[56] C. Patramurti and D. M. Virginia, “Genetic CYP2A6 Polymorphism may worsen glycohemoglobin levels: study among javanese Indonesian Smokers,” Borneo Journal of Pharmacy, vol. 7, no. 1, pp. 29–39, Feb. 2024, doi: 10.33084/bjop.v7i1.5467.

[57] J. Maddatu, E. Anderson-baucum, C. Evans-molina, and I. Physiology, “Smoking and the risk of type 2 diabetes,” Transl Res., no. 184, pp. 101–107, 2017, doi: 10.1016/j.trsl.2017.02.004.Smoking.

[58] P. A. Prasojo and C. Patramurti, “CYP2A6*4 allele gene high frequency associated with low-density lipoprotein cholesterol (LDL-C) among Javanese Indonesian smokers,” Pharmaciana, vol. 11, no. 2, p. 293, 2021, doi: 10.12928/pharmaciana.v11i2.20744.

[59] I. Mappangara, I. Yusuf, A. Aspar Mappahya, and A. Qanitha, “CYP2A6 gene polymorphism and severity of coronary atherosclerosis in Indonesian male smokers: A pilot study,” Medicine (United States), vol. 101, no. 37, p. E30308, Sep. 2022, doi: 10.1097/MD.0000000000030308.

[60] K. Feingold, “Dyslipidemia in patients with diabetes,” in Diabetes and Kidney Disease, Second Edition, K. Feingold, B. Anawalt, M. Blackman, and E. et al., Eds., South Dartmouth (MA): Endotext [Internet], 2023, pp. 341–360. [Online]. Available: https://www.ncbi.nlm.nih.gov/books/NBK305900/

[61] J. P. Kane, C. R. Pullinger, I. D. Goldfine, and M. J. Malloy, “Dyslipidemia and diabetes mellitus: Role of lipoprotein species and interrelated pathways of lipid metabolism in diabetes mellitus,” Curr Opin Pharmacol, vol. 61, pp. 21–27, Dec. 2021, doi: 10.1016/j.coph.2021.08.013.

[62] Z. Seemab Amin et al., “Dyslipidemia In Type 2 diabetes mellitus patients,” J Surv Fish Sci, vol. 10, no. 3, pp. 202–212, 2023, [Online]. Available: https://www.researchgate.net/publication/374700495

[63] R. M. Handy and G. P. Holloway, “Insights into the development of insulin resistance: Unraveling the
interaction of physical inactivity, lipid metabolism and mitochondrial biology,” Front Physiol, vol. 14, 2023, doi: 10.3389/fphys.2023.1151389.

[64] R. B. Jain and A. Ducatman, “Associations between smoking and lipid/lipoprotein concentrations among US adults aged ≥20 years,” J Circ Biomark, vol. 7, pp. 1–10, 2018, doi: 10.1177/1849454418779310.

[65] I. Wakabayashi, “Smoking and lipid-related indices in patients with diabetes mellitus,” Diabetic Medicine, vol. 31, no. 7, pp. 868–878, 2014, doi: 10.1111/dme.12430.

[66] G. Bruschetta and S. Diano, “The smoke clears over diabetes,” Nature, vol. 574, pp. 336–337, 2019.

[67] D. Kar et al., “Relationship of cardiometabolic parameters in non smokers, current smokers, and quitters in
diabetes : a systematic review and meta analysis,” Cardiovasc Diabetol, pp. 1–15, 2016, doi: 10.1186/s12933-016-0475-5.

[68] M. Alves-Bezerra and D. E. Cohen, “Triglyceride metabolism in the liver,” Compr Physiol, vol. 8, no. 1, pp. 1–22, 2018, doi: 10.1002/cphy.c170012.

[69] Q. N. Raddam and M. M. Zeidan, “Effects of smoking on the level of lipase enzyme and lipid profile in blood serum of young smokers,” Medico-Legal Update, vol. 20, no. 2, pp. 814–819, 2020, doi: 10.37506/mlu.v20i2.1216.

[70] Y. Yang et al., “Interaction between smoking and diabetes in relation to subsequent risk of cardiovascular events,” Cardiovasc Diabetol, vol. 21, no. 1, pp. 1–12, 2022, doi: 10.1186/s12933-022-01447-2.

[71] Perkumpulan Endokrinologi Indonesia (PERKENI), pedoman pengelolaan dan pencegahan diabetes melitus tipe 2 dewasa di Indonesia - 2021, Dr. dr. Soebagijo Adi Soelistijo, SpPD-KEMD, FINASIM, FACP, et al., Eds. Jakarta: PB PERKENI, 2021.

[72] F. F. Alkaff et al., “The ımpact of the ındonesian chronic disease management program (PROLANIS) on Metabolic control and renal function of type 2 diabetes mellitus patients in primary care Setting,” J Prim Care Community Health, vol. 12, 2021, doi: 10.1177/2150132720984409.
Published
2025-11-18
How to Cite
PATRAMURTI, Christine; VIRGINIA, Dita Maria. Smoking as a risk factor for dyslipidemia: study among type 2 diabetes mellitus patients on private hospital in Yogyakarta. JURNAL ILMU KEFARMASIAN INDONESIA, [S.l.], v. 23, n. 2, p. 314-324, nov. 2025. ISSN 2614-6495. Available at: <http://jifi.farmasi.univpancasila.ac.id/index.php/jifi/article/view/1720>. Date accessed: 28 dec. 2025. doi: https://doi.org/10.35814/jifi.v23i2.1720.
Section
Articles